2010-04-08_PERMIT FILE - M2008012

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FORM NO. GWS31 0412005 WELL CONSTRUCTION AND TEST REPORT STATE OF COLORADO, OFFICE OF THE STATE ENGINEER 1313 Sherman St., Roam 818, Denver. CO 80203 Phone - Info (303) 866 -3587 Main (303) 866 -3581 Fax 303 866 3589 h1tp:11%vww.water.state.co.us For Office Use Only 1. WELL PERMIT NUMBER: MH -48088 2. WELL OWNER INFORMATION NAME OF WELL OWNER: Nuvemco, LLG MAILING ADDRESS: 107713200 Road CITY. Hotchkiss STATE: CO Zip CODE: 81419 TELEPHONE NUMBER: 970 872 - 3009 3. WELL LOCATION AS DRILLED NE 114, SE 114, Sec. 18 , Twp. 46 21 N or El S, Range 17 ❑ E or ❑� W DISTANCES FROM SEC. LINES: ft. from ❑ N or ❑ S section line and ft. from ❑ E or ❑ W section line. SUBDIVISION: LOT , BLOCK , FILING (UNIT) - Owner's Well Designation: MMW1 Optional GPS Location: GPS Unit must use the following settings: Format must be UTM, Units Easting: 694,356.2 m E must be meters, Datum must be NAD83, Unit must be set to true N, 0 Zone 12 or ❑ Zone 13 STREET ADDRESS AT WI=LL LOCATION: N 4,234,476.1 m N 4. GROUND SURFACE ELEVATION 6454 feet DRILLING METHOD Air Rata DATE COMPLETED 10 -1 -08 TOTAL DEPTH 640 feet DEPTH COMPLETED 310 feet S. GEOLOGIC LOG: 6. HOLE DIAM in. From (ft) TO (ft Depth Typ Grain Size Color Water Loc. 6.5 0 340 7. PLAIN CASING: flush joint Schedule 40 OD (in) Kind Wall Size (in) From (ft) To (f) 2 PVC 3116 +2 270 2 PVC 3116 300 310 PERFORATED CASING: Screen Slot Size (in): 20 2 PVC 3116 270 300 I I SEE FOLLOWING PAGEI 8. FILTER PACK Material sand Size 10-20 Interval 250 -310 9. PACKER PLACEMENT: Type Depth 0. GROUTING RECORD Material Amount Density Interval Placement bnt chips 5 ax 10 -3 hand Remarks: See comments on following page. bnt chips 18 sx 270' hand lost circulation Amt. Used 11. DISINFECTION: Type NA 12. WELL TEST DATA: ❑ Check box if Test Data is submitted on Form Number GWS 39 Supplemental Well Test. TESTING METHOD Bailer Static Level 290 fL Date/Time measured: 10-1 -0 200 Production Rate 0 gprn. Pumping Level 310 ft. Datelrme measured 10 -1 -06, 3:00 - Test Length (hrs) 1 Remarks: Well was dry on 10-2,10-3,10-8, and 10 -23 13. 1 have read the statements made herein and know the contents thereof, and they are true to my knowledge. This document is signed and certified in accordance with Rule 17.4 of the Water Well Construction Rules, 2 CCR 402 -2- [The filing of a document that contains false statements is a violation of section 37-91-108(1) C.R.S., and is Runishable by fines up to $5000 and/or revocation of the contracting license. Company Name: Phone: cense Number. O &G Environmental Consulting 720 529 -9777 -10483 Mailing Address: 11 Inverness Way South, Englewood, CO 80112 Signature Print Name and Title Date ti E. Thomas Cavanaugh Operations Manager 11 -2-08